The global prevalence of female genital mutilation/cutting: A systematic review and meta-analysis of national, regional, facility and school-based studies

Abstract

Background: Female Genital Mutilation/Cutting (FGM/C) is a non-medical procedure entailing the modification of the external female genitalia. The Sustainable Development Goals aim to end FGM/C by 2030. This systematic review aimed to examine FGM/C prevalence and types, by World Health Organization (WHO) region and country. Methods and Findings: A systematic search using MeSH headings and keywords from inception to March 2, 2020 was undertaken in MEDLINE, PsycINFO, Web of Science, and Embase to identify studies presenting FGM/C prevalence. Abstract and full-text screening, quality assessment, and data extraction were undertaken by two reviewers. Only nationally representative studies were included in the meta-analysis. Pooled FGM/C prevalence was estimated by meta-analysis using random effects models. FGM/C prevalence and types were presented separately by women aged 15-49 and girls aged 0-14. 3,205 articles were identified. 135 met the inclusion criteria and 28 were included in the meta-analysis. Across 27 countries, the pooled prevalence estimate of FGM/C in women aged 15-49 was 40% (95% CI: 26-55%; I2 =100%), and 15% (95% CI: 10-21%; I2 =100%) in girls aged 0-14 across 34 countries. The country with the highest FGM/C prevalence in women was Guinea (97%) and the lowest, Uganda (0.3%). The highest prevalence in girls was in Mali (77%), and the lowest in Ghana (0%). The most common category of FGM/C was flesh removed at 69% (women) and 70% (girls). Limitations include that studies had heterogeneous terminology and relied on recall. Conclusions: There is large variation in FGM/C prevalence, and the lower prevalence in the current generation of girls is encouraging. However, considerable policy and community-level interventions are required to meet the SDG. Future research should consider collecting data on the 15-19 age group in order to accurately assess generational differences in FGM prevalence. The study protocol is available: https://osf.io/ema9j/.